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다발성 골수종에 대한 Vincristine , Melphalan 및 Prednisone ( VMP ) 복합화학요법의 치료 효과
김태유(Tae You Kim),허대석(Dae Seog Heo),방영주(Yung Jue Bang),박선양(Seon Yang Park),김병국(Byoung Kook Kim),김노경(Noe Kyeong Kim),김효진(Hyo Jin Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.1
N/A Background: The combination of melphalan and prednisone has been the standard therapy for multiple myeloma. However, owing to the emergence of the drug resistance, essentially most patients have relapse or progrssion during chemotherapy. Vincristine was reported to be albe to prevent the development of the resistance to melphalan. Methods: Sixty two patients with multiple myeloma were treated with a combination chemotherapy of vincristine, melphalan and prednisone (VMF). The regimen consists of vincristine 0.03 mg/kg i.v. (day 1), melphalan 0,1 mg/kg p.o. (day 1-7) and prednisone 1mg/kg p.o. (day 1-7), which was repeated every four weeks. Results: Among 51 evaluable patients, 29 patients (56%) achieved objective responses. The median duration of response was 15 months. The median time to progression of overall patients was 11 months. The factors influencing response were age (p<0.04) and performance status (p<0.03). The overall median surivival was 36 months. The single most important factor associated with prolonged survival was the responsiveness to remission induction chemotherapy (p<0.001). Leukopenia was observed in 42% and thrombocytopenia in 2%. Neurotoxicity due to vincristine was found in 5.2% of the patients. Conclusions: The VMP regimen was associated with relatively high response rate and well tolerted, producing only mild bone marrow suppression and neuratoxicity. This result shows that VMP combination chemotherapy is an effective treatment regimen for multiple myeloma.
Aggressive 비호즈킨 림프종의 예후인자 분석과 고위험군 환자 선별을 위한 International Prognostic Index Model
김경태(Kyung Tae Kim),김태유(Tae You Kim),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),이창희(Chang Hee Lee),곽영임(Young Im Kwak),류백렬(Baek Yeol Ryoo),성주병(Ju Byeung Sung),이영우(Young Wo Lee),장은정(Eun Jung Jang),김재학(Jae Ha 대한내과학회 1997 대한내과학회지 Vol.53 No.3
N/A Objective: Although the therapeutic outcome of aggressive non-Hodgkin's lymphoma (NHL) has been considerably improved by the introduction of combination chemotherapy, many patients still fail to achieve complete response(CR) and/or long-term survival. Because the outcome appears to depend on certain prognostic factors, long term prognosis can be predicted by identification of risk group. And also, the patients in high risk group may benefit from new therapeutic modality. In 1993, the international prognostic index model for aggressive NHL as developed far the purpose of predicting outcome and designing of therapeutic trial. Thus, analysis of prognostic factors was performed to identify independent factors for the end points of CR, overall survival, and disease-free survival. Methods : From 1989 to 1994, total 340 patients were treated with combination chemotherapy and/or radiotherapy for NHL in Korea Cancer Center Hospital. Among 340, informations on eleven prognostic factors(sex, age, performance status, Ann Arbor stage, serum LDH level, tumor size, number of extranodal disease sites, bone marrow involvement, presence of B symptom, sex, time to CR, and histologic grade) were avaliable for 273 patients. Among these, 221 patients with aggressive NHL(NCI clinical schema) were eligible for the prognostic factor analysis for the response and survival. Also, 186 patients were eligible to determine whether International Prognostic Index Model could be applicable for Korean NHL. Results: One hundred fifty patients(68%, 95% CI 62-74%) achieved a complete remission, 43 patients (20%) a partial remission. With a median follow-up of 3,5 years, overall 3 year survival rate was 6396, and 3 year DFS for the 150 CRs was 72%. In a univariate analysis for the CR and survival, Ann Arbor stage, number of extranadal disease, performance status, presence of B symptoms, presence of BM involvement, serum LDH level and histologic grade were found to be statistically significant prognostic factors. Among them, by multivariate analysis, number of extranodal disease(RR 0.2, 95% CI 0.1-0.7), B Symptoms (RR 0.4, 95% CI 0.2-0.9), and histologic grade(RR 0.2, 95% CI 0.08-0.7) showed to be independent adverse prognostic factors for CR. For disease-free survival, Ann Arbor stage(RR 2.6, 95% CI 1.1-6.4) was independent risk factor. For overall survival, number of extranodal involvement(RR 2, 95% CI 1.3-4) and histologic grade(RR 2, 95% CI 1.2-3.7) were independently significant prognostic factors. With these 2 independent prognostic factors for survival, we could establish a prognastic index model which could separate the high risk patients. However, the usefulness of this model should be confirmed in a larger patient population. The dose intensity of cyclophosphamide, during initial 3 months of treatment, was significantly associated with CR rate and overall survival(p=0.01 & 0.03, respectively). When International Prognostic Index Model was applied to our patients, patients in the lower risk groups had significantly better outcome than patients in the higher risk groups(3 year survival and RR: 77% & 1 for low risk group, 61% & 1.9 for low-intermediate risk group, 50% & 2.2 for high-intermediate risk group, and 25% & 6 for high risk group). Conclusion: In this study, we confirmed that features other than the Ann Arbor stage were independently associated with CR and survival, and the International Prognostic Index Model would be an useful tool for the selection of high-risk patients who could be benefited from more aggressive chemotherapy.
Klinefelter 증후군에 병발된 원발성 종격동 생식세포종
김용조 ( Yong Jo Kim ),권교선 ( Gyo Seon Kwun ),이영우 ( Young Wo Lee ),김경태 ( Kyung Tae Kim ),박연희 ( Yeon Hee Park ),류백렬 ( Baek Yeol Ryoo ),김태유 ( Tae You Kim ),임영혁 ( Young Hyuck Im ),이춘택 ( Choon Taek Lee ),강윤구 대한결핵 및 호흡기학회 1996 Tuberculosis and Respiratory Diseases Vol.43 No.6
간이식 후 발생한 간세포암의 폐 전이에 대한 종양절제술의 역할
김현수(Hyun Soo Kim),서경석(Kyung-Suk Suh),전영민(Young-Min Jun),김태훈(Teahoon Kim),신우영(Woo Young Shin),이남준(Nam-Joon Yi),한국남(Kook Nam Han),김영태(Young Tae Kim),김태유(Tae-You Kim),이건욱(Kuhn Uk Lee) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.4
Purpose: Liver transplantation (LT) has been advocated as a good management option for patients with hepatocellular carcinoma (HCC). The rate of HCC recurrence after LT is about 20%. Although the median survival time of patients with HCC recurrence is 7∼9 months, the role of surgical treatment for metastatic tumors has been reported on. In this study, we evaluated the role of metastasectomy for treating patients with pulmonary metastasis from HCC after LT. Methods: We retrospectively analyzed 10 patients with pulmonary metastasis after LT and who were treated between April 2005 and October 2007. The underlying liver disease was cirrhosis caused by chronic viral hepatitis. The surveillance protocol for HCC recurrence was as follows: assessing the serum alpha-fetoprotein level every 1 month, chest and abdomen-pelvic computed tomography every 3 months and a bone scan every 1 year or when bone metastasis was suspected. The patients with less than 3 metastatic lesions were recommended to undergo metastasectomy (Group S, n=6) and the patients with more 4 lesions were recommended nonsurgical management, including chemotherapy (Group N, n=4). Results: All the metastatic lesions were detected on the protocol chest CT scans. The median recurrence time was 7.4 months (0.8∼18.2) after LT; this was 11.0 (4.8∼18.2) months for Group S and 2.0 (0.8∼3.3) months for Group N. One patient had a single lesion and the others had multiple lesions on multilobes. The median survival times of Group S were 29.3 (18.5∼41.3) months after pulmonary metastasis and 40.3 (23.3∼48.0) months after transplantation; 5 patients had no recorded evidence of their disease status. The median survival time of Group N was 4.3 (4.0∼6.3) months after metastasis and 6.2 (5.3∼7.1) months after transplantation; all the patients have since died. Conclusion: The survival outcome seemed to be good for the patients who underwent pulmonary metastasectomy for HCC, if it was detected earlier and it was resectable (≤3 lesions). However, further study is required for validating the survival benefit of pulmonary metastasectomy.
재발성 및 전이성 대장암에 대한 Irinotecan, 고용량 Leucovorin, 5-Fluorouracil 복합 화학요법의 치료결과
김지현 ( Jee Hyun Kim ),김도연 ( Do Yeun Kim ),이세훈 ( Se Hoon Lee ),박숙련 ( Sook Ryun Park ),이상윤 ( Sang Yoon Lee ),최인실 ( In Sil Choi ),김태유 ( Tae You Kim ),허대석 ( Dae Seog Heo ),방영주 ( Yung Jue Bang ),김노경 ( Noe K 대한내과학회 2003 대한내과학회지 Vol.64 No.4
목적 : Irinotecan은 진행성 대장암에서 5-FU, leuco-vorin과 복합하여 1차 요법으로 사용하였을 때, 약 30~40%의 반응율을 보이는 효과적인 약제이다. 아직 irinotecan과 5-FU/leucovorin을 어떤 용량과 방법으로 복합하는 것이 우월한지는 정립되지 않은 실정이다. 저자들은 진행성 대장암 환자를 대상으로 irinotecan/LV5FU2 복합 화학요법의 효과와 독성을 평가하고자 하였다. 방법 : 2000년 6월 1일부 Background : Irinotecan is an active agent in colorectal cancer, producing 30~40% response rates when combined with 5-fluorouracil and leucovorin in metastatic colorectal cancer as first line therapy, however, the best combination schedules are not determ
김미숙(Mi Sook Kim),류성렬(Seoung Yul Yoo),조철구(Chul Koo Cho),유형준, 김재영(Jae Young Kim),심재원(Jae Won Shim),이춘택(Choon Taek Lee),강윤구(Yoon Koo Kang),김태유(Tae You Kim) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.3
목 적 : 비소세포폐암으로 근치적 방사선치료를 시행받은 환자의 생존율 및 예후인자를 알아보기 위하여 본 연구를 시행하였다. 방 법 : 1992년 1월부터 1993년 12월까지 수술이 불가능한 비소세포폐암으로 원자력병원 치료방사선과에서 40Gy 이상의 근치적 방사선치료를 시행받은 62명의 환자에 대해 후향적으로 치료 결과를 분석하였다. 병기별 분포는 병기 IIIA 14예, 병기 IIIB 48예였다. 방사선치료는 일일 선량 1.8-2.0Gy씩 주 5회로 원발병소에 총 40.0-70.2Gy의 방사선을 조사하였다. 환자중 37예에서 유도 화학요법을 시행하였다. 결 과 : 방사선 치료 후 반응은 완전 관해가 3예, 부분관해가 34예였다. 그외는 무반응이였다. 전체환자의 중앙 생존기간은 11개월이었으며 1년 생존율은 45.0%, 2년 생존율은 14.3%였고 5년 생존율은 6.0%였다. 병기에 따른 1년 생존율 및 중간 생존기간은 각각 병기 IIIA에서 28.6%, 6.5개월, 병기 IIIB에서 50.3%, 13개월이였다. 단변수 분석에서 생존율에 영향을 미치는 예후인자로는 T 병기, 병기, 방사선 치료 직후의 반응이 통계학적으로 의미가 있었고(P<0.05) 연령, 성별, 병리학적 소견, N 병기, 쇄골상 림프절 전이 유무, 화학 요법 시행유무 등은 통계학적으로 의미가 없었다(P>0.1). 그외 치료전 전신상태는 통계학적 의미는 없었지만 생존율에 영향을 주는 경향을 보여주었다(0.05<P<0.1). 다변수 분석상 병리학적 소견, 방사선치료직후의 반응이 의미있는 예후인자였고 T 병기는 통계학적으로 의미는 없었지만 생존율과 관련된 경향을 보여주었다. 추적기간 중 20예에서 원격전이가 관찰되었으며 그중 골전이가 10예, 뇌 전이 3예, 간 전이 3예, 폐전이 1예였고 그외는 다발적으로 발생하였다. 결 론 : 비소세포폐암 환자에서 전통적인 방사선 단독 치료 또는 유도화학요법을 병행하는 것만으로는 장기생존율을 기대하기 어려우며 좀더 적극적인 치료방법의 도입이 필요한다. 저자들의 병원에서는 국소 제어율을 높이기 위하여 방사선치료와 함께 병행화학요법을 시행한후 가능한환자를 대상으로 하여 수술의 적용을 시행하고 있어 그 결과가 주목된다. Purpose : This study was done to evaluate the survival rate and prognostic factors of patients with inoperable non-small cell lung cancer(NSCLC) treated with radiation therapy. Materials and Methods : A retrospective analysis was undertaken of 62 patients who had inoperable NSCLC treated with radiation therapy from January 1991 through December 1993. According to AJCC staging, stage ⅢA was 14 patients and stage ⅢB was 48 patients. Forty Gy to 70.2Gy to the primary tumor site was delivered with daily fractions of 1.8Gy or 2Gy, 5 days per week. Thirty-seven patients received neoadjuvant chemotherapy. Results : Complete, partial and no response to radiation therapy were 3 patients, 34 patients and 25 patients, respectively. The median survival period of all patients was 11 month. One year survival rate, 2 year survival rate and 5 year survival rate for all patients were 45.0%, 14.3%, and 6.0% respectively. The median survival period was 6.5 months in stage ⅢA and 13 months in stage ⅢB. One year survival rates were 28.6% in stage ⅢA and 50.3% in stage ⅢB. In univariaite analysis, prognostic factors affecting survival were T-staging, AJCC staging, and response after radiation therapy (P<0.05). Pretreatment peformance status affected survival but was not statistically significant (0.05<P<0.1). Survival was not affected by age, sex, pathologic finding, N staging, supraclavicular lymph node status, and neoadjuvant chemotherapy (P>0.1). In multivariate analysis, pathology and response to radiation therapy are independently significant prognostic factor. T stage was marginally significant (P=0.0809). During follow -up duration, distant metastasis developed in 20 patients-bone metastasis in 10 patients, brain metastasis in 3 patients, liver mentastasis in 3 patients, contralateral lung metastasis in 1 patients and multiple metastases in 3 patients. Conclusion : Conventional radiotherapy alone or combined chemoradiotherapy are unlikely to achieve long term survival in patients with NSCLC. Surgery after concurrent chemoradiotherapy is tried to improve the local control in our hospital
김동완 ( Dong Wan Kim ),류민희 ( Min Hee Ryu ),김태유 ( Tae You Kim ),허대석 ( Dae Seog Heo ),방영주 ( Yung Jue Bang ),박재갑 ( Jae Gahb Park ),김노경 ( Noe Kyeong Kim ) 대한내과학회 2003 대한내과학회지 Vol.64 No.3
목적 : 본 연구의 목적은 한국인 대장암 환자의 생존율에 영향을 미치는 예후인자를 분석하는 것이다. 방법 : 1990년 1월부터 1992년 12월 까지 조직학적으로 대장암 진단을 받은 406명의 환자를 대상으로 임상적, 병리학적, 실험실적 변수를 후향적으로 조사하였다. 생명표범을 이용하여 생존율을 구하였고, 로그-랭크법으로 단변량 분석을 통해 독립예후인자를 결정하였다. 결과 : 결장암의 5년 전체 생존율은 58.1%, 직장암의 5년 전체 생존율은 58% Background : It is the aim of this study to find out the prognostic factors in Korean colorectal cancer patients Methods : The analysis was performed on 406 patients diagnosed as colorectal cancer between Jan, 1990 and Dec. 1992. Survival rate was calcula